THE URINARY

SYSTEM
JEN ARAGON, MD
DECEMBER 2015

KIDNEY FUNCTIONS

Regulation of blood ionic composition

Regulation of blood pH
Regulation of blood volume
Regulation of blood pressure
Maintenance of blood osmolarity

Production of hormones (calcitriol and

erythropoietin)
Regulation of blood glucose level
Excretion of wastes from metabolic
reactions and foreign substances (drugs
or toxins)

RENAL ANATOMY
Renal hilum indentation where the
ureter emerges along with blood vessels,
lymphatic vessels and nerves
Renal capsule continuous with outer
coat of ureter, barrier against trauma,
maintains kidney shape

Adipose capsule mass of fatty tissue

that protects kidney from trauma and
holds it in place
Renal fascia superficial layer thin
layer of connective tissue that anchors
kidney to surrounding structures and
abdominal wall

PATH OF BLOOD FLOW

KIDNEYS
Renal

cortex superficial

Outer cortical zone

Inner juxtamedullary zone

Renal columns portions of cortex

that extend between renal pyramids

 Renal

medulla inner region

Several cone shaped renal pyramids

base faces cortex and renal papilla
points toward hilum

Renal

lobe renal pyramid,

overlying cortex area, and of each
adjacent renal column

 Parenchyma

(functional portion) of

kidney

Renal cortex and renal pyramids of

medulla

Nephron

microscopic functional
units of kidney

 Urine

formed by nephron drains into:

Collecting

ducts
Papillary ducts
Minor and major calyces
Renal pelvis
Ureter
Urinary bladder

NEPHRON
2

parts
1. Renal corpuscle filters blood
plasma
Glomerulus capillary network
Glomerular (Bowmans) capsule

double-walled cup surrounding

glomerulus

2. Renal

tubule where glomerular

filtrate passes into
Proximal convoluted tubule
Descending and ascending loop
of Henle (nephron loop)
Distal convoluted tubule

Renal corpuscle and both convoluted

tubules lie in the cortex, loop of Henle
extends into the medulla
Distal convoluted tubule of several
nephrons empty into single collecting duct
Cortical nephrons 80-85% of nephrons
Renal corpuscle in outer portion of
cortex and short loops of Henle extend
only into outer region of medulla

Juxtamedullary nephrons other 15-20%

Renal corpuscle deep in cortex and long
loops of Henle extend deep into medulla
Receive blood from peritubular capillaries
and vasa recta
Ascending limb has thick and thin regions
Enable kidney to secrete very dilute or
very concentrated urine

HISTOLOGY OF THE NEPHRON &

COLLECTING DUCTS

Glomerular capsule
Visceral layer has podocytes that wrap
projections around single layer of endothelial
cells of glomerular capillaries and form inner
wall of capsule
Parietal layer forms outer wall of capsule
Fluid filtered from glomerular capillaries
enters capsular (Bowmans) space

RENAL TUBULE AND COLLECTING

DUCT

Juxtaglomerular apparatus helps regulate

blood pressure in kidney
Macula densa cells in final part of
ascending loop of Henle; crowded columnar
cells
Juxtaglomerular cells cells of afferent and
efferent arterioles contain modified smooth
muscle fibers

Proximal convoluted tubule cells have

microvilli with brush border increases
surface area
Last part of distal convoluted tubule and
collecting duct

Principal

cells receptors for antidiuretic

hormone (ADH) and aldosterone
Intercalated cells role in blood pH
homeostasis

RENAL PHYSIOLOGY:
OVERVIEW
1. Glomerular filtration
Water and most solutes

in blood plasma
move across the wall of the glomerular
capillaries into glomerular capsule and then
renal tubule

2. Tubular reabsorption
As filtered fluid moves along tubule and
through collecting duct, about 99% of water
and many useful solutes reabsorbed
returned to blood
3.Tubular secretion
As filtered fluid moves along tubule and
through collecting duct, other material
secreted into fluid such as wastes, drugs,
and excess ions removes substances from
blood

Solutes in the fluid that drains into

the renal pelvis remain in the fluid
and are excreted
Excretion of any solute = glomerular
filtration + secretion - reabsorption

STRUCTURES AND FUNCTIONS OF A

NEPHRON
Renal corpuscle
Afferent
arteriole

Renal tubule and collecting duct

Glomerular
capsule
Fluid in
renal tubule

1 Filtration from blood

plasma into nephron

2 Tubular reabsorption
from fluid into blood

Efferent
arteriole

Peritubular capillaries

Copyright 2009, John Wiley & Sons, Inc.

3 Tubular secretion
from blood into fluid

Urine
(contains
excreted
substances)

Blood
(contains
reabsorbed
substances)

GLOMERULAR FILTRATION
Glomerular

filtrate fluid that enters

capsular space

Daily volume 150-180 liters more than

99% returned to blood plasma via tubular
reabsorption

 Filtration

membrane endothelial cells of

glomerular capillaries and podocytes
encircling capillaries

Permits filtration of water and small solutes

Prevents filtration of most plasma proteins,
blood cells and platelets

3 barriers to cross:
1. glomerular endothelial cells fenestrations,
2. basal lamina between endothelium and
podocytes
3. pedicels of podocytes create filtration slits

Volume of fluid filtered is large because of

large surface area, thin and porous
membrane, and high glomerular capillary
blood pressure

NET FILTRATION PRESSURE

NFP = GBHP CHP BCOP
Glomerular blood hydrostatic pressure
is the blood pressure of the glomerular
capillaries forcing water and solutes
through filtration slits

Capsular hydrostatic pressure is the

hydrostatic pressure exerted against the
filtration membrane by fluid already in the
capsular space and represents back
pressure
Blood colloid osmotic pressure due to
presence of proteins (albumin, globulin,
fibrinogen) in blood plasma and also
opposes filtration

1 GLOMERULAR BLOOD
HYDROSTATIC PRESSURE
(GBHP) = 55 mmHg

2 CAPSULAR HYDROSTATIC
PRESSURE (CHP) = 15 mmHg
3 BLOOD COLLOID
OSMOTIC PRESSURE
(BCOP) = 30 mmHg

Afferent arteriole

Proximal convoluted tubule

Efferent
arteriole

NET FILTRATION PRESSURE (NFP)

=GBHP CHP BCOP
= 55 mmHg 15 mmHg 30 mmHg
= 10 mmHg
Glomerular
(Bowman's) Capsular
capsule
space

GLOMERULAR FILTRATION RATE

Glomerular filtration rate amount of filtrate

formed in all the renal corpuscles of both
kidneys each minute

Homeostasis requires kidneys maintain a

relatively constant GFR
Too high substances pass too quickly and are not
reabsorbed
Too low nearly all reabsorbed and some waste
products not adequately excreted

MECHANISMS REGULATING
GFR

1. RENAL AUTOREGULATION

Kidneys themselves maintain constant renal

blood flow and GFR using

Myogenic mechanism occurs when stretching

triggers contraction of smooth muscle cells in
afferent arterioles reduces GFR
Tubuloglomerular mechanism macula densa
provides feedback to glomerulus, inhibits release of
NO causing afferent arterioles to constrict and
decreasing GFR

2. NEURAL REGULATION

Kidney blood vessels supplied by

sympathetic ANS fibers that release
norepinephrine causing vasoconstriction
Moderate stimulation both afferent and
efferent arterioles constrict to same
degree and GFR decreases
Greater stimulation constricts afferent
arterioles more and GFR drops

3. HORMONAL REGULATION

Angiotensin II reduces GFR potent

vasoconstrictor of both afferent and
efferent arterioles
Atrial natriuretic peptide increases
GFR stretching of atria causes
release, increases capillary surface area
for filtration

TUBULAR REABSORPTION

Reabsorption return of most of the filtered

water and many solutes to the bloodstream
About 99% of filtered water reabsorbed
Proximal convoluted tubule cells make largest
contribution
Both active and passive processes

TUBULAR SECRETION

Secretion transfer of material from blood

into tubular fluid
Helps control blood pH
Helps eliminate substances from the body

REABSORPTION ROUTES

Paracellular reabsorption
- water and solutes in tubular fluid return to
the bloodstream by moving between tubule
cells
- Tight junction do not completely seal off
interstitial fluid from tubule fluid
- Passive

 Transcellular

reabsorption
solutes and water in tubular
fluid return to the bloodstream by
passing through a tubule cell

TRANSPORT MECHANISMS

Reabsorption of Na+ especially important

Primary active transport

Secondary active transport

Symporters, antiporters

Transport maximum (Tm)

Sodium-potassium pumps in basolateral membrane only

Upper limit to how fast it can work

Obligatory vs. facultative water reabsorption

REABSORPTION AND
SECRETION IN THE PCT
Largest amount of solute and water reabsorption
Secretes variable amounts of H+, NH4+ and urea
Most solute reabsorption involves Na+

Symporters for glucose, amino acids, lactic acid,

water-soluble vitamins, phosphate and sulfate
Na+ / H+ antiporter causes Na+ to be reabsorbed and
H+ to be secreted

 Solute

reabsorption promotes osmosis

creates osmotic gradient
Aquaporin-1 in cells lining PCT and
descending limb of loop of Henle
As water leaves tubular fluid, solute
concentration increases

Urea

and ammonia in blood are filtered

at glomerulus and secreted by proximal
convoluted tubule cells

REABSORPTION IN THE LOOP

OF HENLE
Chemical

composition of tubular fluid

quite different from filtrate

Glucose, amino acids and other nutrients

reabsorbed

Osmolarity

still close to that of blood

Reabsorption of water and solutes balanced

Independent regulation of both volume and

osmolarity of body fluids
Na+-K+-2Cl- symporters function in Na+ and
Cl- reabsorption promotes reabsorption of
cations
Little or no water is reabsorbed in ascending
limb osmolarity decreases

REABSORPTION ON THE EARLY

DISTAL CONVOLUTED TUBULE
Na+-Cl- symporters reabsorb Na+ and Cl Major site where parathyroid hormone
stimulates reabsorption of Ca+ depending
on bodys needs

REABSORPTION AND SECRETION IN

THE LATE DCT AND COLLECTING DUCT

90-95% of filtered solutes and fluid have been

returned by now
Principal cells reabsorb Na+ and secrete K+
Intercalated cells reabsorb K+ and HCO3- and
secrete H+
Amount of water reabsorption and solute
reabsorption and secretion depends on bodys
needs

HORMONAL REGULATION OF TUBULAR

REABSORPTION AND SECRETION

Angiotensin II - when blood volume and

blood pressure decrease
Decreases GFR, enhances
reabsorption of Na+, Cl- and water in
PCT, stimulates adrenals to secrete
aldosterone

Aldosterone - when blood volume and

blood pressure decrease
Stimulates principal cells in collecting
duct to reabsorb more Na+ and Cl- and
secrete more K+
Parathyroid hormone
Stimulates cells in DCT to reabsorb more
Ca2+

 Antidiuretic

hormone (ADH or
vasopressin)

Increases water permeability of cells by

inserting aquaporin-2 in last part of DCT
and collecting duct

PRODUCTION OF DILUTE AND

CONCENTRATED URINE
ADH

controls whether dilute or

concentrated urine is formed
Absent or low ADH = dilute urine
Higher levels = more concentrated urine
through increased water reabsorption

 Atrial

natriuretic peptide (ANP)

Large increase in blood volume

promotes release of ANP
Decreases blood volume and pressure
by inhibiting reabsorption of Na+ and
water in PCT and collecting duct,
suppress secretion of ADH and
aldosterone

URINE TRANSPORTATION, STORAGE,

AND ELIMINATION

Ureters
Each of 2 ureters transports urine from renal
pelvis of one kidney to the bladder
Peristaltic waves, hydrostatic pressure and
gravity move urine
No anatomical valve at the opening of the ureter
into bladder when bladder fills it compresses
the opening and prevents backflow

Urinary bladder
Hollow, distensible muscular organ
Capacity averages 700-800mL
Micturition discharge of urine from bladder
Combination of voluntary and involuntary
muscle contractions
When volume increases stretch receptors
send signals to micturition center in spinal
cord triggering spinal reflex micturition reflex

Urethra
Small tube leading from internal urethral
orifice in floor of bladder to exterior of the
body
In males discharges semen as well as
urine